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J Stroke Cerebrovasc Dis. 2012 Oct;21(7):620.e1-2. doi: 10.1016/j.jstrokecerebrovasdis.2011.02.001. Epub 2011 Mar 16.

Ischemic stroke of the pyramidal decussation causing quadriplegia and anarthria.

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Department of Neurology, University of California at San Francisco, San Francisco, California 94143-0114, USA.


A 52-year-old man with a history of hypertension and previously irradiated head and neck cancer presented with quadriplegia and anarthria sparing the face and sensory functions. Brain magnetic resonance imaging (MRI) demonstrated acute infarction of the pyramidal decussation. We describe the clinical and radiological characteristics of infarction at the pyramidal decussation and review the arterial supply to this region in the lower brainstem. Although rare, infarction of the pyramidal decussation should be considered in the differential diagnosis when patients present with atraumatic pure motor quadriplegia.

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